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Clitoridectomy or clitorectomy is the surgical removal of the clitoris. It is used rarely as a therapeutic medical procedure, such as when cancer has developed in or spread to the clitoris. Most removals of the clitoris occur as female genital mutilation (FGM), defined by the World Health Organization (WHO) as "all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious or other non-therapeutic reasons".[1] This procedure is also ritual practice in certain tribes in Africa.

An estimated 125 million women have had clitoridectomies in 29 countries in Africa and the Middle East where the practice is concentrated. Most of the surgeries are for cultural or religious reasons. FGM is often seen as a rite of passage that makes girls eligible for marriage, and is associated with cultural ideals of femininity and beauty, seen to rid girls of their "unclean" and "male" body parts.[2] Clitoridectomies are performed on intersex newborns to make their genitalia more "understandable".

Cliterodectomies may be performed when there is concern about a person's ability to engage in heterosexual sex that enables reproduction. Anne Fausto-Sterling writes of a woman who had a clitoris large enough to penetrate a vagina, but also had a vagina that could be penetrated by a penis.[3] Fausto-Sterling says this bodily situation is disruptive to current norms about sex that exist because of the pervasiveness of heteronormativity, and says surgeons are preocuppied with the ability to bear children after surgery.[3]

Suzanne Kesler write in Lessons from the intersexed that clitoridectomies are performed on clitorises that are classified as larger than typical, and may be seen as ridding potential normative females of embarrassing phallic structures.[4] The procedure is also condoned by the parents of intersex infants who exhibit grave concern for the ambiguity of their child's genitalia.[4] The procedure is also necessary because a large clitoris challenges the normative female aesthetic because it is "imperfect and ugly".[4]

Another aspect of the normative clitoris is aesthetic. A lack of ambiguity of genitalia is seen as necessary in the assignment of a sex to infants. The idea of ambiguity is shifting, however, since what one sees as ambiguous varies from person to person.[4]

In order for a penis to be considered normal, it had to pass two tests of adequacy. First, if it would allow the boy to be able to pee standing up and feel "normal" and second, the adult man's penis would be large enough for vaginal penetration, which normalizes a heterosexual experience. According to one study of 100 newborn boys, penis size ranged from 2.9 to 4.5 cm. Patricia Donahoe expresses concern about penises 2.0 cm long and says that one less than 1.5 cm long and 0.7 cm wide would result in a female gender assignment. However, many doctors offer advice to parents based on their general observations of the newborn's genitals.[3]

Sarah Rodriguez, writing in Female circumcision and clitoridectomy in the United States, says the history of medical textbooks has indirectly created accepted ideas about the female body. Furthermore, medical and gynecological textbooks are also at fault in the way that the clitoris is described in comparison to a male's penis. In fact, the importance and originality of a female's clitoris is underscored through these contrasting descriptions: "This equation can be seen as a representation of the clitoris as a less significant organ, since anatomy texts compared the penis and the clitoris in only one direction". She says a male's penis created the framework of the sexual organ, which has been considered analogous, to a female's clitoris.[5]

Rodriguez posits that American society has included a male's sexual organ into the understanding of a female's clitoris in the rising notion of the vaginal sex model. Along with understanding the functionality of a clitoris comes with considering a female's sexual response to clitoral stimulation. Contrary to popular belief, most women have stated that they reach orgasm through direct stimulation of the clitoris. However, penetrative sex, also known as the 'male heterosexual response' is considered as normative and thus has created an expectation of how women should act sexually.[5] Rodriguez says that the idea in Americans that a vaginal orgasm was mature and healthy while a clitoral orgasm was not forced a view to not identify the clitoris as a sexual organ. As a result of the confusion regarding whether a healthy female orgasm was clitoral or vaginal, physicians provides surgical procedures such as clitoridectomy.[5]

Four types of female genital mutilation have been identified by the World Health Organization, including Type 1, the clitoridectomy, which involves "partial or total removal of the clitoris and, in very rare cases, only the prepuce (the fold of skin surrounding the clitoris)".[2]

In the clitoral reduction for intersex newborns, the surgeon cuts the shaft of the elongated phallus and sews the glans and preserved nerves back onto the stump. In a less common surgery called clitoral recession, the surgeon hides the clitoral shaft under a fold of skin so only the glans remains visible.[3]

One aspect of a normative clitoris is size. In a study in the American Journal of Perinatology, the clitoral length of eighty-two infants was found to range from 0.2 to 0.85 centimeters, and the width of the clitorises ranged from 0.2 to 0.6 centimeters. In another study, the clitorises of infants that were surgically reduced ranged from 1.5 centimeters to 3.5 centimeters before surgery.[4] It is common to use food terminology such as "pea" or "small bean" to discuss normative sizes of clitorises.

According to Kessler, the procedure illuminates the dual construction of gender: the social construction of gender and the surgical construction of gender. The binary of male and female is constructed socially, as well as in a corporeal sense based on the genitalia that is surgically produced.[4]

There was a 2014 controversy over clitoridectomy on young women athletes as part of a "package" of surgery proposed when they are diagnosed with hyperandrogenism. A policy was introduced by the International Olympic Committee that regulated hyperandrogenism in female athletes, requiring medical investigation of women athletes who were alleged to have hyperandrogenism. Under this policy, four young athletes from developing countries had gonadectomy and partial clitoridectomy after they were identified hyperandrogenic. This policy strongly identifies what it means to be a “normal” woman. It implies that if a woman is “too” good at her sport, it must be because of the male hormone, testosterone, in her body.[6]

Clitoridectomy was once used to curb female masturbation.[7] Gynaecologists in 19th-century Europe and the United States removed the clitoris to treat insanity and masturbation.[8] The first reported clitoridectomy in the West was carried out in 1822 by a surgeon in Berlin, Graefe, on a teenage girl regarded as an "imbecile" who was masturbating frequently.[9]

During the nineteenth century in the West, female circumicism was done for psycho-sexual reasons. According to Victorian medicine, women were vulnerable to emotional disorders and mental diseases due to the nature of their reproductive organs. Their organs, particularly the clitoris was to be tempered. According to the medical theory if exciting the clitoris caused insanity, its removal would cure the neurosis". It was then that the surgical treatment called clitoridectomy was adopted. The application of clitoridectomy continues to exist in Western medicine, but is no longer used to cure female psycho-sexual disorders.[11]

^Rodriguez Sarah W (Jul 2008). "Rethinking the history of female circumcision and clitoridectomy: American medicine and female sexuality in the late nineteenth century". Journal of the History of Medicine and Allied Sciences63 (3): 323–47. doi:10.1093/jhmas/jrm044. PMID18065832.